medgate today magazine - nov-dec 2015

The Gateway to Health & Medical World

Volume VI || Issue IV || Nov.-Dec. 2015

www.medgatetoday.com Price : ` 100/-

News Update | Doctor Speak | Expert Views | Product Line | Industry Watch | Healthcare Management

Healthcare Architecture

Doctor as an Entrepreneur

Healthcare infrastructure

www.medegatetoday.com Nov.-Dec. 20154

EVENTSPEAK

4

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Volume - VI Issue - IV Nov.-Dec. 2015

magazine

Dr. ma Kamal

Dr. Pradeep Bhardawaj, Razi ahsanGP Capt. (Dr.) Sanjeev SoodDr. Sharad Lakhotia

afzal Kamal

Deepti Tripathi

Rizan Khan

amjad Kamal, SY ahmed Khan, Ranjit Shirsath Nizamuddin alam

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all right Reserved by all everts are made to insure that the information published iscorrect 'medgate today’ holds no responsibility any unlikely errors that might occur.

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Can a doctor act as an entrepreneur?

The answer lies within

Now a day’s doctors are not only limited to clinics and operation theaters, as they have stepped ahead and broken the stereotypes about playing the role of an entrepreneur in the Healthcare domain. Doctors have broadened their horizons and are working successfully, as entrepreneurs in the Healthcare Industry. When Doctors takes the authority as a businessman they perform more better, as they anticipate a well defined vision and knows the priorities of the operations carried out in a hospital .As medical industry is still bearing the brunt of inadequate funds in India ,so therefore one needs to use the funds very wisely in the Healthcare business and an Entrepreneur Doctor knows where to pump in the money for providing the better healthcare for their patients.Of course loads of money is required for purchasing the medical equipments , but apart from that People often compromise with the healthcare architecture and they don’t know the importance of it .Recent studies have shown that evidence based design which is also known as the healing design ,which is incorporated by a healthcare architect while designing also affects , in the process of recovery and has the ability to heal patients .These are the technicalities which a doctor can only understand .The other important factor in the healing process is the infection control in the hospitals, which is generally neglected by general entrepreneurs, but it is a matter of concern for the people who are visiting the hospital and for the patients too. So a Doctor cannot afford to forget this infection control factor, as every year so many people die due to this problem.The ultimate aim of every healthcare player is to provide the comfort zone and patient satisfaction in the treatment and only an entrepreneur doctor can sense and feel the real needs of the patients.

Have an insightful reading.Your suggestions are most welcome!E-mail: [email protected]: w w w . m e d g a t e t o d a y . c o m

Contents

18

Child Mortality

Dr. Rajiva

Kumar

20

Swallowing

problems

Dr. Rajiv Baijal

22

Underestimation

of stroke can

make ......

Dr. (Prof.) V. S. Mehta

30

HOW TO PLAN

EXPANSION

OF YOUR

HOSPITAL

Dr. Vinod Singh

32

HOW TO SETUP

your hospital...

Doctor as

Entrepreneurs

Dr. Ashihs Davalbhakta

33

How to set up an

IVD Diagnostic

laboratory

Dr. R. Selva Kumar

10

Brands Achiever Healthcare Award of Excellence 2015

61

TechnologyPaving the Way for InnovationMunish Daga

21

Apeejay Stya & Svran Group organiseS IOG Dr. Stya Paul Awards 2015

36

Brands Achiever Healthcare Award of Excellence 2015Hafeez Arcitech

A Proud moment for India as the largest human trial on ��8Airox tied up with Telelift, Germany The World’s Leading Medical ��12Social Stigma is a major barrier for Mental Health Care: Psychiatrists ��14Touch Screen smart phones and tablets can cause Arthritis ��14A good healthy design with an eco-friendly ambience in hospitals ��24Doctor As An ENTREPRENEUR ��26Healthcare Project Strategy Building the Infrastructure around ��28Nabh Accreditation not That Difficult ��34Conference on Pharmacology R&D for Minimizing ADRs and Role ��38Medical booms in India as Apollo hospitals takes the lead ��40Architect Mauktik Trivedi explains his style of healthcare Architecture ��42Known as the design legend in the field of architecture��44Dr� R� Chandrashekhar who revolutionized the healthcare architecture ��46Call Systems, Bed-Head Panels, Pendants ��48Visocall IP from Schrack Seconet ��50Scanning the Indian Healthcare Infrastructure ��52Breast Cancers can be completely cured if detected in early stages ��54Don’t ignore your bone health ��56Importance of Medical Records in Medico-Legal Cases ��58Medical Inventions That Save Lives ��62Healthcare priorities and technical knowledge about the hospital ��66


UpdateNEWS

The most important thing that I consider is that this study being done in India has hit the world international

recognition for an Indian trial coming at a very high platform .Never in the past , any study done in India specially in Cardiology in this specialty reached such heights. The proof of that is presented as late breaking trial in one of the biggest international conferences for angioplasty and related fields called TCT and the proof is that it got published now on the same date in the New England Medical journal which is one of the most prestigious journals in the world in Medical sciences with highest impact factor of 57 and other journals like Lancet , jama they are number two at 35, the difference between these journals is phenomenal .Study getting published in the New England Medical journal is an honor. This is one of the most prestigious

thing for the country that Indian trial being recognized internationally because Indian scientific trials have been looked at with suspicions ,doubts and also with reliability of data ,so this is a proof that we have the potential to do.

1830 patients is a big number for a study in which angioplasty has been done on all patients .For a study in which angioplasty has been done in all the patients ,Its not the blood pressure measuring study and it’s the largest trial in Diabetes conducted in Diabetic patient population .It has done our country proud and it was done to prove or disprove hypothesis because when we do angioplasty we have different kinds of drug eluting stents ,so these two kinds of drug eluting stents which is paclitaxel eluting stent and everolimus -eluting stent .SO there has been a lingering controversy which stent is better in diabetes and the opinions were divergent one group claiming based upon data meta analysis in which Smaller studies showing possibly everolimus stent is better than Paclimaxtal as in general everolimus is better ,so this controversy was there for more than decade and this study has sorted out controversy by showing the everolimus drug eluting stent is not only more efficacious but also safer. This articles also questions the previous studies of Bypass surgery versus angioplasty in Diabetic patients. All those studies done by first generation stents , it has questioned those studies also .This study was sponsored by Fortis escorts. The funding was done by Boston Scientific

A Proud moment for IndIA as the largest human trial on diabetes conducted by dr. upendra Kaul got published in the new england medical Journal.

but the centre who gave the funds has nothing to do with the design of the study ,nature of the study and they came to know about the results of the study after it was published .

Paclitaxel who lost this battlefield and the irony is that the company which funded this whole study is the maker of the stent Paclitaxel who lost .It makes it even more scientific that they did not interfere.

How ethical was the Study .

The trials have not been conducted properly earlier as there have been controversies regarding this and it has been talked also in the media about Conduction of Human trials .This study is totally ethical as we proposed this project to Drug controller of India in 2010 which is a regulatory body . we got the approval after 6 months then we started the whole trial. This study has been conducted after taking the clearances from all ethical bodies .we have been through ethics committee and they also gave the approval .we have taken approval from 46 institutions for this study as India is very good in regulations .This has also shown that India can also do ethical trials as far as the regulations are concerned .As far as the patients are concerned ,total consent of patient has been taken in the whole study and when the rules of consenting changed then the last 100 patients, we have taken audio –visual consent. So this journal wont accept any study which has got even iota of doubt and in this context this trial is purely ethical .

Prof. Dr Upendra Kaul Dean Executive Director Cardiology and Academics Research

Fortis Escort Hospital (Delhi)

UpdateNEWS

AwArd of Excellence2015

Brands Achiever Healthcare

Mr. Ajay Jadeja ( Former Indian Cricketer) Were The Chief Guest And Our Host Ms. Payal Rohatgi(Indian Actress, Model And Reality Tv Performer) & Guest Of Honor At The Gala Ceremony And Gave Away The Award Certificates And Trophy To The Winners, Which Included Organizations From All Across India.

Brands Achiever Is One Of The Leading Market Research Company Organized Best Brands Of The Year With Media Telecast : Abp News Product Partner - Surbhi Gramodyog Vikas Sansthan, And Co-Sponsored By Jindal Panther Tmt Rebars, Shree Balaji Group To Felicitate India's Best, Hospitals, Surgeons, Doctors. The Event Was Held In New Delhi

The Awards Were Based On A Comprehensive Market Research Study And Opinion Surveys Conducted By Brands Achiever.



UpdateNEWS

Aurangabad, Maharashtra - Airox Technologies Pvt. Ltd. a leading name in Indian Healthcare Industry known for introducing newer healthcare technologies in India. Airox launched Airsep Oxygen Generator Systems in private hospital in India which has created major revolution in Indian healthcare market & has more than 150 customers across India. Airox is un-challengingly a market leader with 90% market share in private hospital segment.

Airox has entered into agreement & tied up with Telelift – Medical Logistics, a product based on German Technology which is expected to revolutionize the Indian Healthcare Sector impacting the modern hospitals and the way they operate.

Telefift - Medical Logistic Solution is a fast & safe automated material transport system inside the hospital which can carry weight up to 15 Kg and is capable of transporting sterile goods, surgical instruments, drips, blood bags, pharmaceuticals, medical goods, intravenous medications ,blood & Laboratory specimens, medical records, documentation, morphine & other highly effective drugs, even cash as it has complete code locking system.

Telelift has more than 1300 installation across the globe. Few of their customers are,

• Singapore General Hospital, Singapore• Niguarda Ca ́Granda Hospital, Milano, Italy• Central Hospital Augsburg, Germany• Paediatric University Clinic Düsseldorf, Germany• Nikiforov Russian Centre of Emergency and Radiation

Medicine St. Petersburg, Russia• Yancheng No. 3 People’s Hospital, China

Airox tied up with Telelift, GermanyThe World’s Leading Medical Logistics Partner

African leaders meet with Indian Prime Minister Narendra Modi in New Delhi for an African Union-India meeting this week, Médecins Sans Frontières/Doctors Without Borders (MSF) urged African governments and India to work together to maintain trade in affordable generic medicines that is a lifeline for millions of people in India, Africa and other developing countries.

India is under considerable bilateral pressure from the United States and other developed countries to roll back its pro-public-health intellectual property policies that has put access to vital lifesaving generic drugs above the profits of multinational pharmaceutical companies. India is known as the ‘pharmacy of the developing world,’ with more than 80% of HIV medicines used in developing countries, for example, being generics from India.

“In 2005 when India needed to amend its patent laws, the government made the conscious decision to protect people over profits and implemented some key pro-public health provisions”, said Leena Menghaney, Head-South Asia, MSF Access Campaign. “India’s policies have allowed for the production of affordable generic medicines which many millions of people across the developing world, including Africa, rely on.”

The historical lack of patent barriers in India opened up generic production of some older antiretroviral drugs, allowing the price of HIV drugs to be driven down from over US$10,000 per person per year in 2000; today the recommended first-line treatment costs governments in Africa and India just over $100 per patient per year, and 15 million people in the developing world now receive HIV treatment.

African Union–India meeting in Delhi, African leaders and India should work together to protect access to affordable medicines

U.S. Food and Drug Administration approved Strensiq (asfotase alfa) as the first approved treatment for perinatal, infantile and juvenile-onset hypophosphatasia (HPP). HPP is a rare, genetic, progressive, metabolic disease in which patients experience devastating effects on multiple systems of the body, leading to severe disability and life-threatening complications. It is characterized by

FDA approves new treatment for rare metabolic disorderdefective bone mineralization that can lead to rickets and softening of the bones that result in skeletal abnormalities. It can also cause complications such as profound muscle weakness with loss of mobility, seizures, pain, respiratory failure and premature death. Severe forms of HPP affect an estimated one in 100,000 newborns, but milder cases, such as those that appear in childhood or adulthood, may occur more frequently.

“For the first time, the HPP community will have access to an approved therapy for this rare disease,” said Amy G. Egan, M.D., M.P.H., deputy director of the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research (CDER). “Strensiq’s approval is an example of how the Breakthrough Therapy Designation program can bring new and needed treatments to people with rare diseases.”

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UpdateNEWS

Mental health issues are common across all sections of the society. One in five people world over

suffers from psychiatric disorders at some point in their lives. It is estimated that globally over 450 million people suffer from mental disorders. Three of the ten leading causes of disability worldwide in people between the ages of 15 and 44 are disorders related to mental health. However, despite mental health issues posing serious public health concerns, mental well-being is generally amongst the most neglected health issues.“The social stigma that surrounds mental health creates a barrier for early identification and seeking timely help for psychiatric disorders. Barely about a quarter of people with mental health problems in our country receive on-going treatment, leaving a vast majority

Excessive use of touch screen smart phones and tablets can lead to wrist and finger joint pain, arthritis and repetitive stress

injuries of your hands, arms and back, warn orthopaedic experts.

As constant use of touch screen phone, smart phone and tablets has led to an increase over the past few years in the number of people complaining of aches and pains in their fingers, thumbs and hands. This pain and stiffness may be the result of a Repetitive Stress Injury (RSI), which occur when the same motion is repeated over and over again, for a long period of time, causing inflammation in the ligaments and tendons of joints, said Dr. Raju Vaishya, President of Arthritis Care Foundation (AFC) & Senior Consultant Orthopaedic Surgeon at Indraprastha Apollo Hospitals, New Delhi.Those who indulge in too much gamming and texting on touch screen smart phones and tablets can suffer from wrist and finger joint pain and some time crippling arthritis of fingers. Longer duration of gamming and texting can cause wrist and finger joint pain. In the age group of young children, longer use of gaming devices is associated with more pain, said Dr. Ramneek Mahajan, Director Orthopaedics & Joint Replacement, Saket City Hospital, New Delhi.

Social Stigma is a major barrier for Mental

Health Care: Psychiatrists

According to Dr. Ramneek Mahajan, Repetitive Stress Injuries can result from recurrent large or small movements that affect joints, muscles, tendons, and nerves. For example, people who frequently use their thumbs to type text messages on cell phones sometimes develop radial styloid tenosynovitis (also called De Quervain syndrome, BlackBerry thumb or texting thumb), a painful affliction that involves the tendons that move the thumb. Although the causal link isn't as well established as in patients who suffer from pain from prolonged desktop keyboard use, there's little doubt that overzealous texting can cause debilitating pain, .Dr. Ramneek Mahajan said that most people use touch screen in unnatural and wrong postures. Stress related injuries can also occur when people use their bodies in ways that induce physical stress, such as tilting their hands too far inward or outward while tapping or putting force on their wrists while typing. Carpal tunnel syndrome, perhaps the best-known disease in this category, results from pressure on the median nerve in the wrist.

grappling with mental health issues on their own,” says Dr Sunil Mittal, Senior Psychiatrist and chairperson at the Cosmos Institute of Mental Health & Behavioural Sciences (CIMBS), New Delhi.“Persons with mental health problems are often discriminated against and marginalised in the society. At times, they may also be victims of physical as well as emotional abuse in the community. This further worsens the stigma that

surrounds mental health problems, and holds people back from disclosing and therefore seeking help for their mental health related problems. A vicious cycle ensues, , adding to the burden of disease for the individual as well as the society,” says Dr Sunil Mittal, Senior Psychiatrist and chairperson at the Cosmos Institute of Mental Health & Behavioural Sciences (CIMBS), New Delhi.“There is a need to de-stigmatize mental health related issues and ensure that persons with mental health problems have equal opportunities for living with dignity through upholding their human rights, developing suitable policies, generating awareness in society and promoting a respectful and supportive atmosphere. Also, emphasis has to be given on promoting positive mental health and well-being. After all, ‘health’ is incomplete without sound mental health,” says Dr Sunil Mittal, Senior Psychiatrist and chairperson at the Cosmos Institute of Mental Health & Behavioural Sciences (CIMBS), New Delhi.

Touch Screen smart phones and tablets can cause Arthritis and Repetitive Stress Injuries


UpdateNEWS

23 year old girl suffering from end stage heart disease gets a heart transplant at Fortis Escorts Heart Institute and steps out in the World for a new innings

This week the U.S. Food and Drug Administration filed complaints initiating the first-ever No-Tobacco-Sale Order (NTSO) actions for a group of retailers who have repeatedly violated certain restrictions on the sale and distribution of tobacco products, including sales to minors. Under the law, the FDA may pursue an NTSO against retailers that have a total of five or more repeated violations of those restrictions during compliance inspections within 36 months.

“Retailers are the first line of defense in preventing the illegal sale of harmful and addictive products like cigarettes and smokeless tobacco to youth,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “These enforcement actions will send a powerful message to all retailers that there are real consequences for repeatedly violating the law.”

Tobacco sellers who sold tobacco products repeatedly to minors targeted by FDA who took enforcement action against them .

The U.S. Food and Drug Administration today approved Imlygic (talimogene laherparepvec), the first FDA-approved oncolytic virus therapy, for the treatment of melanoma lesions in the skin and lymph nodes.“Melanoma is a serious disease that can advance and spread to other parts of the body, where it becomes difficult to treat,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research. “This approval provides patients and health care providers with a novel treatment for melanoma.”Skin cancer is the most common form of cancer in the United States. Melanoma,

one type of skin cancer, is the leading cause of skin cancer related deaths, and is most often caused by exposure to ultraviolet (UV) light. According to the National Cancer Institute approximately 74,000 Americans will be diagnosed with melanoma and nearly 10,000 will die from the disease in 2015.Imlygic, a genetically modified live oncolytic herpes virus therapy, is used to treat melanoma lesions that cannot be removed completely by surgery. Imlygic is injected directly into the melanoma lesions, where it replicates inside cancer cells and causes the cells to rupture and die.

The first of its kind product for the treatment of melanoma approved by FDA

The U.S. Food and Drug Administration today approved Onivyde (irinotecan liposome injection), in combination with fluorouracil and leucovorin, to treat patients with advanced (metastatic) pancreatic cancer who have been previously treated with gemcitabine-based chemotherapy.

FDA approves new treatment for advanced pancreatic cancer

According to the National Cancer Institute, there will be 48,960 new cases of pancreatic cancer diagnosed in the U.S. in 2015, and nearly the same number of deaths caused by the disease (40,560). Pancreatic cancer can be difficult to diagnose early and treatment options are limited, especially when the disease has spread to other parts of the body (metastatic disease) and surgery to remove the tumor is not possible.

• 23 year old patient gets a new lease of life after nine years of uncertainty

• Heart transplant is the only treatment for idiopathic restrictive cardiomyopathy causing end stage heart failure

• The latest development in the medical field is to take the heart from a death occurred after circulatory death as an additional option to the conventional retrieval of organs from a brain dead donor.-

Fortis Escorts Heart Institute bids adieu post the recovery period to 23 year old patient, Oshin Goyal who has just received a new lease of life with a heart transplant. The transplant was performed by Dr. Z S Meharwal, Director & Coordinator, Cardiovascular Surgery Fortis Escorts Heart Institute. The donor, a 58 year old man, suffered a brain hemorrhage and was rushed to a local hospital. The patient was referred to Fortis Memorial Research Institute (FMRI) when the doctors at a nearby hospital failed to revive him. The heart reached the recipient in just 27 minutes 56 seconds and the surgical procedure for the transplant took four hours for completion.Oshin Goyal is a young girl at 23 years of age and had been suffering from restrictive cardio myopathy since the last nine years. She initially had swelling of her feet and legs and gradually developed worsening breathlessness, abdomen and face. she was diagnosed with a rare cardiac condition called Restrictive Cardiomyopathy and was treated at our heart failure centre.


DOCTORSPEAK

Child Mortality Lack of basic amenities leading to astonishing aftermaths as

Rates keeps on rising in developing nations therefore jeopardizing tomorrow.

Child mortality is the child death under the age of 5 years or between 1 month to 4 years. The present scenario in the world has raised concerns for identifying drastically

increasing child mortality rate and finding ways for reducing it in order to achieve the Millennium development goal by 2015.According to the latest reports of World health organization 9.2 million children under five are dying every year, down from over 12 million in 1990.Most of these children are dying in the developing countries from preventable causes for which there are known and cost –effective interventions. 5.4 million child deaths per year can be prevented if proper efforts are made for this cause. More than one billion children don’t get necessary goods and services which are must for the human survival and these essential needs are nutrition ,water, sanitation facilities ,access to basic healthcare services ,adequate shelter, education and information. Therefore as a result ,9.2 million children under five die every year. Most of the 25000 children under five who die each day are from the Worlds poorest countries like sub-Saharan Africa and south Asia .In fact the child mortality rate is 29 times greater than in Industrialized countries according to the reports of World health organization.

When we talk about Child mortality rate ,no one can forget the second most populous country India who Unfortunately missed the child mortality target of 2015 ,according to the lancet report

.India also tops the charts when it comes to Child mortality as the highest number of child deaths are witnessed in 2015 ,with an estimated 1.2 million deaths in 2015.

The third most populous state in India is Bihar and in fact the child population is 19.13 million in the 0-6 years age group .Therefore Bihar is having the second highest child population in India accounting to 12 percent of the total child population in this age group. Bihar is one of the poorest states in India with almost 33.7 percent of population living in poverty. As Bihar takes the 5th position in terms of death of children below 5 years of age.70 children per 1000 live births die every year in the state of Bihar and in terms of death tolls, least number of kids died in Patna while Sitamarhi recorded the Highest numbers.The sex ratio of Bihar is pathetic as it is having the fourth lowest sex ratio which is 925 females out of 1000 males. Kishanganj is doing better but Sitamarhi, Purnia and Darbhanga are worst districts.

The causes of Child mortality in Bihar are mainly inadequate healthcare facilities and malnutrition factors as the state lives in extreme poverty .These reports clearly presents the inside picture of Bihar particularly in child mortality rates and sex ratio difference .Therefore Health authorities and institutions must take immediate steps and initiatives for improving the condition of the state.

The third most populous state in India is Bihar and in fact the child population is 19.13 million in the 0-6 years age group .Therefore Bihar is having the second highest child population in India accounting to 12 percent of the total child population in this age group.Bihar is one of the poorest states in India with almost 33.7 percent of population living in poverty.

Dr. Rajiva KumarChild Specialist (Muzaffarpur)


DOCTORSPEAK

Hydrogen Breath Test – the latest innovation to diagnose carbohydrate intolerance

It is a non-invasive test that uses the measurement of hydrogen in the breath to diagnose several conditions that cause symptoms like abdominal bloating, gas formation and diarrhea.Symptoms: Gas formation Abdominal bloating Chronic diarrheaIndications: Sugar intolerance (lactose, fructose, sucrose, sorbitol). Small intestinal bacterial overgrowth Irritable bowel syndromeOnly anaerobic bacteria in the large intestine, when exposed to unabsorbed sugars,are capable of producing hydrogen. This is absorbed into the blood flowing through the intestine and exhaled in the breath.ProcedurePrior to the test, the patient fasts for at least 12 hours. The test is safe and no sedation is required.

Swallowing problemS, heartburn, conStipation or diarrhea? new teStS to diagnoSe the underlying diSorder

The patient blows into the mouthpiece of a hand-held monitor and the concentration of hydrogen is measured. The patient then ingests a small amount of the test sugar (lactose, sucrose, sorbitol, fructose, lactulose or glucose depending on the purpose of the test). Additional samples of breath are collected and analyzed for hydrogen every 15 - 20 minutes for 2 – 3 hours.Interpretation of the results

Depending upon the substrate used, a rise in breath hydrogen of more than 12-20 ppm from the baseline is considered as positive hydrogen breath test.Based on the results, dietary advice and medications are prescribed as required.A precise test to evaluate esophageal functionEsophageal manometry is a test to measure the pressure in the esophagus and assess its motility, rhythmicity, coordination and force of peristalsis. This helps in diagnosis and management of esophageal motility disorders.Symptoms and indications:

It is required in patients who have difficulty in swallowing, painful swallowing,heartburn, non-cardiac chest pain, achalasia cardia, scleroderma, refractory reflux disease and prior to anti-reflux surgery for GERD.It helps in diagnosing these disorders precisely and planning their medical, endoscopic or surgical treatment.Procedure:

It is a safe procedure done without sedating the patient.The patient has to be fasting for a minimum of six hours.The manometry catheter is passed through the nose into the esophagus and the patient is made to swallow sips of water. A computer connected to the

catheter records the pressure, strength and pattern of esophageal peristalsis.The test takes around 15-20 minutes.A computerized report is given at the end of the procedure. Further management is planned based on the results.Anorectal Manometry - Categorise constipationIt is a test to evaluate bowel movement in patients with constipation or fecal incontinence.It measures strength of the anal sphincter muscles, sensation of stool in the rectum, reflexes that control anal sphincter and the movements of the rectal and anal muscles.Indications:

It is required in cases of constipation, especially difficulty in stool evacuation (dyssynergic defecation), fecal incontinence, Hirschsprung disease and to evaluate anorectal movement before or after anorectal surgery.Procedure:

It is a safe procedure done without sedating the patient. Bowel cleansing is required prior to the procedure, but fasting is not required.

Dr. Rajiv BaijalSenior Consultant, Gastroenterology

PSRI Hospital, New Delhi

www.medegatetoday.com Nov.-Dec. 2015 21

DOCTORSPEAK

A thin manometry catheter with a balloon attached at its tip is introduced into the rectum to record the pressure of the rectum and anal sphincter.The patient is asked to perform certain maneuvers such as to relax or squeeze the anal sphincter and bear down as if to pass stool.The test takes about 15-20 minutes.Based on the manometry findings, biofeedback therapy may be recommended to help improve constipation or fecal incontinence.Biofeedback therapy involves neuromuscular conditioning technique using a manometry probe with multiple micro-transducers placed inside the rectum. Visual cues on the computer screen show the patient the contraction and relaxation of anorectal muscles in the form of different colors. Patients are taught breathing exercises, relaxation and contraction of the anal sphincter. The patient is also advised regarding bowel habits, exercise, laxatives, dietary fibres and fluid intake and timed toilet training.These tests help in the correct classification of the disorder and proper management of the patient.

The Apeejay Stya & Svran Group organised the Indian Obstetrics and Gynaecology (IOG) Dr. Stya Paul Awards 2015 at the Apeejay Campus, Sheikh Sarai, New Delhi, on 31st October 2015. The occasion witnessed a galaxy of esteemed doctors and dignitaries from across the country. The IOG Dr. Stya Paul Awards have been instituted to recognise outstanding body of academic and scientific quest in the domain of Gynaecology & Obstetrics.

Commemorating the legacy of Dr. Stya Paul, a great visionary and philanthropist, who championed the cause of women empowerment and child development in the country throughout his life, an Oration Lecture by Professor Ian Fraser was organised on the very relevant topic of ‘Current Trends in the Medical Management of Endometriosis’. Professor Ian Fraser was previously a Professor in Reproductive Medicine, University of Sydney and Subspecialist in Reproductive Endocrinology and Infertility, Royal Prince Alfred Hospital, Sydney. He is a Past-President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and Past-Honorary Secretary of the International Federation of Gynaecology and Obstetrics (FIGO). He has published over 450 peer-reviewed papers in his on-going research career.It is estimated that approximately 26 million Indian women between the ages of 18 and 35 are afflicted by this disease and as much as upto 50% of women are affected in terms of their fertility due to endometriosis. Despite its increasing prevalence, it is not discussed to that great extent and that it should be addressed in various clinical meetings & research summits. The Oration Lecture on Endometriosis will go a long way in shedding light on the myriad aspects of this medical condition and its treatment.

ApeejAy StyA & SvrAn Group orGAniSeS ioG

DR. STYA PAUL AWARDS 2015


DOCTORSPEAK

An altered lifestyle which includes sedentary jobs, high levels of work

stress and a lifestyle where smoking and

alcohol consumption are considered trendy leads to

an increase in stroke cases. Some other risk factors associated with strokes

include hypertension, diabetes, obesity,

nutritional deficiency and high cholesterol

amongst others

Paras Hospitals discusses concerns regarding stroke epidemic in India

Underestimation of stroke can make things worse in the walk of life and can lead to death as India expected to report 1.6 million cases of stroke by 20

15

Stroke has emerged as a leading cause of death and disability in India Stroke takes place on account of poor blood flow to the brain

India is following the footprints of other developing countries as a vast part of its population is

suffering from both communicable and non-communicable diseases. Stroke claims a large number of victims in the country and the estimated prevalence rate of stroke range in the country is 84-262/100,000 in rural and 334-424/100,000 in urban areas, stated National Center for Biotechnology Information (NCBI), U.S.Unfortunately, the health burden caused by stroke is highly underestimated in India. Consequently, it does not get as much attention as other ailments like cardiovascular disease and diabetes.As per NCBI estimates, India is likely to report1.6 million cases of stroke on an annual basis by the year 2015, of which nearly one-third of them will be disabled. A city like Gurgaon also faces major challenges as far as stroke cases are concerned. Further, a sedentary lifestyle, unhealthy diet, hypertension, and rising stress levels make people highly susceptible to strokes.“Stroke occurs when blood flow to the brain gets disrupted causing death of cells. Lack of blood flow caused, either by blockage or by hammeorage or bleeding causes damage to the

affected part of the brain. Strokes are classified into two major categories: ischemic and hemorrhagic. Ischemic strokes happen when blood supply is interrupted to the brain whereas hemorrhagic strokes occur if a blood vessel breaks down. Nearly 87% of the strokes are ischemic and the remaining are hemorrhagic,” says Dr. (Prof.) V. S.

Mehta, Padamshree, Chief of Neurosciences, Paras Hospitals, Gurgaon.

WHO has e s t i m a t e d that by the year 2050,

As per NCBI estimates, India is likely to report1.6 million

cases of stroke on an annual basis by the year 2015, of which nearly one-third of them will be disabled. A

city like Gurgaon also faces major challenges as far as

stroke cases are concerned. Further, a sedentary lifestyle, unhealthy diet, hypertension, long working hours and rising

stress levels make people highly susceptible to strokes.


COVERStORY

A good healthy design

with an eco-friendly ambience in

hospitals can act a catalyst in the process of healing


COVERSTORY

People have a perception that Doctors are an abysmal business people and they are only limited

to taking care of patients ,doing procedures in operation theatres etc .But this idea is very much outdated now ,as the contemporary scenario is very much different because doctors are turning into big entrepreneurs now a days across the world. People argue how a doctor can be an entrepreneur as they hardly know about business but the fact is that they have a huge potential and can become a terrific entrepreneurs.What are the commonalities which makes a doctor a good entrepreneur. Establishing a business for a doctor is not a big deal now because entrepreneurship is also similar as it require proper research and experimentation in which doctors are expert too because research and experiments are the daily routine for them with their patients. The most important factor in a business is uncertainty and having an ability to take a right decision is a bit daunting process but doctors deal with uncertainty everyday in their profession and are very good in taking decisions spontaneously .Only 25-35%of decisions are based on scientific evidence ,so they also take decisions with incomplete information depending on the situation like business people do. Doctors know how to build a clinical judgement. They learn from their mistakes and this gives them experience and learning from experience is called clinical judgement. They learn from the mistakes and makes the judgement for the future opportunities.

entrePreneurAs An

The Idea behind doctor as an entrepreneur can be demonstrated easily by understanding the concept of Film Industry .In the process of film

making there is whole team of people who works for the success of the film. There are key people like producers who produce the film and they do not intervene in the rest of the process and leave everything for the

director who gives life to his vision in his own way. They also hire actors who can efficiently perform for the particular role and can influence

the audience. In the same way Investors should invest in the vision of a doctor and should not interfere in the process as the Doctor is the Director of the start up and he knows who can act really well in the business and

can hire skillful people who can make a difference in the vision and can act on the plot created by him for the business.

Dr. Dharmendra Nagar Managing Director and CEO of Paras hospitals said” Being a doctor gives an entrepreneur in the healthcare industry a unique advantage. One is already equipped with the clinical knowledge but when you cross the line of evolving aspects as an administrator, you face the challenge of what would be the things that one would need. A doctor is able to list the basic, the added and the exceptional requirements needed easily. Moreover patient insight, expectations and disease patterns are already familiar terms for a doctor. Through my personal experience of being a doctor, administrator and entrepreneur in Paras Healthcare, I have been able to work on the most important aspect that clinical science has taught us- Work on details to achieve excellence'.

Dr. Dinesh Batra who is the Director of Cygnus Multispecialty Hospitals said “If we really want to solve the problem of the peripheral India in terms of Healthcare service delivery in areas of (Trauma, Medical intensive care and cardiology )then we need to incubate doctors as an entrepreneur and provide them a platform under which they can work together in a structured manner and can also focus on providing quality in the hospitals'.


COVERStORY

No one could have really imagined that how a design can help in healing patients as people generally think that healing patients is a healthcare domain.In the Recent years after extensive research on something called evidence based design has been done .Evidence based design basically emphasizes on credible evidence to influence design .This approach is been used in the Healthcare Industry in order to improve patient and staff well being ,patient healing and also helps in reducing stress.In the healthcare Healing designs means designing environments for the patients which can help them in their recovery.

After all what constitutes a Healing design Healing design are basically patient centric as they help in the recovery of patients.Healthcare architects prefer building a hospital in a peaceful environment where noise should not disturb the ambience and evidence based design also suggest that surroundings play an integral role in the recovery of patients .Proper ventilation systems in the patients room ,exposure of sunlight and eco-friendly environment where scenic beauties can be seen heals patient more quickly as compared to hospitals who lack all these facilities. There is a new trend of hospital gardens which has been added in the Hospital designs where local flora has been added where patients can relax and breathe in a very pure and natural environment in order to get recovered and this releases stress too.

When we think about healing ambience ,what comes to mind ?A spa ?A japanese Garden?May be a corner of your house?Some would immediately think of a clinic or hospital.Healthcare organizations are becoming aware from the advantages and benefits of a healing environment and are incorporating ideas developed by healthcare architects in order to produce the healing environment .They are also taking heart ideas from Environmental Psychology ,geography,sociology ,landscape,interior design ,architecture ,nursing,medicine and public health research which shows that how specific designs can affect healthcare ambience which would help in reducing stress and also lessensthe physical outcomes associated with it.Architect Mauktik Trived said “Modern healthcare architecture is not only about Hi tech materials & swanky forms. Healthcare Architecture can elevate the level of performance significantly. It creates a healing environment that not only soothes the ailing patients but also relieves the anxiety of attendants. Use of natural light, wise selection of materials, strategically located adequate no.s of Hand-wash area helps reducing androgenic infections.Proper space allocation for casualty, colour coding, signage helps the ill patients & stressed relatives.Ideal healthcare design should be patient friendly and staff friendly too so that patients get best treatment from the staff who are at their maximum level of comfort in their service area.Design should have provision for current & future services including IT integrity is essential & inevitable for ever advancing medical science”.


COVERSTORY

What are the activities that entrepeneurs should not do��Entrepreneurship is a marathon,

even if all your stars are aligned and your vision is defined then also an entrepreneur faces unexpected challenges in the course of time .There are possibilities that the growth of your business may be slow than you anticipated it and may be you have to use more manpower and time for customer support but all this should not matter because one should a long vision and patience is must .An entrepreneur should not expect success overnight .

�There are many people with Ivy league degrees and excellent IQs who started business and have failed very badly .So in this capacity, an entrepreneur should know the History before they start their business in any field. There can be chances where people have tried the same idea and have failed. Inspite of ignoring the companies who failed, an entrepreneur should learn and analyze before embarking on a new venture.

�There is a very common belief in young entrepreneurs that money will solve all the problems which is a big misconception and due to this many people suffer a failure .Capital is very much important in the business but it should be utilized and allocated in a proper manner in order to produce better results. There should be proper business model for the investment of funds and then one can expect productive results.

�Dont let investors rule the company and try to maintain cordial relationship with them because you will need their money for the carrying out the operations of the company. Investors always wants quick returns .They want companies to spend more money and expect big profit returns. So this approach may not work and for building a lasting company .

�Dont operate inside a bubble ,an entrepreneur should have knowledge and must be aware with the market Dont ignore the outside world and always be informed.

Doctors have the core entrepreneurial skills as they know how to question, observe, connect and associate .The innovators DNA, Christensen et.al noted the core skills of the innovators are questioning, associating, connecting, observing,, experimenting credit (Hannibal).Doctors have all these skills. Doctors have the ability to take decisions during risky periods and in fact most of the medical decisions are based on the risk versus benefits. The entire concept of doctor being an entrepreneur is based on the fact that they both share same characteristics and qualities.What qualities entrepreneurs should have� They should be full of determination

and they should have a clear vision and goals defined in order to run a smooth business .This is a challenge for many people because if you are not determined then you might face a crisis in your business. Entrepreneurs should be brave enough to take risks and should be able to produce maximum with the minimum resources. High-level of confidence is the key to get out from all kinds stressful situations .

�An entrepreneur should always embark on something which he/she is familiar with .There are many advantages of doing business of something which person already knows as it gets easy to figure out the needs and demands of the client.You will be having a clear vision about the company and you can communicate with your employees more effectively. So always land up with something that you already know and rather than starting something that you don’t know.

Dr. Naveen Nischal who is the Director of operations and quality in Cygnus hospitals said” Passion, Perseverance and team player qualities are essential ingredients to become a successful entrepreneur.

�When someone starts a new business, then there are lot of areas where a person gets stuck ,finds hard to decide due to lack of knowledge. Successful entrepreneurs keeps a very humble approach in their whole career and they don’t hesitate in taking help from people in order to run their business smoothly.

�People never recognize there mistakes and specially entrepreneurs who rely on optimism during hard times. Ignoring a mistake and allowing it to fester can be harmful and costly in the business So one should have the courage to admit the mistake and should work on it for the improvement.

ANY DOUBTS

AM A WHITE COLLAR BUSINESS MANi

?


COVERSTORY

Every major hospital has expansion plans these days to tap into the relatively unexplored market in

Indian healthcare. This results in people getting better access to healthcare even in Tier II & Tier III towns. If you are planning for expansion of your hospital business by taking over some Brownfield projects/going for Greenfield projects, you should be aware of the fact that it requires a strong backing of the investors & justify the investment of the project. If it is done by a single promoter or a group of doctors, one or more of them need to have a risk taking profile/capability in order to venture into this line.We may look at the word ‘Expansion’ not just to increasing your hospital presence in different regions but also to expand in the same premises by acquiring the land adjacent to the existing hospital thereby increasing the total bed capacity. Let’s discuss both these aspects here.So…What makes you think of expanding your existing hospital? Is it the lack of number of beds? Lack of

services? Lack of waiting area? Need for Up-gradation & renovation? Unable to survive competition? The reason could be any or many more. But the point is, Is it really necessary?

There are times when the hospital goes through a period when it receives a higher number of patients in a certain season & other times there is no occupancy. How do you justify expansion of the hospital in such case?

What I am trying to say here is, if an expansion strategy has worked for the neighboring hospital it isn’t necessary it

HOW TO PLAN EXPANSION OF YOUR HOSPITAL

should work for you too. Although, you might be working in a same locality, the services might be different & the brand value might be entirely different. Plan your hospital expansion carefully. An alternative of this could be that you might think of setting up another hospital (Mid size) in a different catchment area rather than expanding in the existing premises.

Expansion Project should always include a major expansion of existing services to meet increasing demand and the creation of new services to reduce the need for the people to travel out of the area for treatment. To make sure you get it right, talk to staff, patients, carers and the community about how you can improve the hospital experience. Listen to what people want. Based on suggestions from patients and carers, you could introduce new ways to help reduce stress and create a more relaxed environment in the hospital.

Redeveloping to address growing demands• To address the significant increase in

patient volumes and congestion it’s seen in recent years, a multi-phase multi-year redevelopment of the hospital is proposed to increase its capacity.

• Redevelopment will allow the hospital to provide the latest in-patient-centred care and design, enhance the working environment for clinicians and employees, and provide a significant increase in healthcare services and capacity for the communities served. Expansion or renovation typically depends on the actual needs which could be:

• New Critical care departments• New Diagnostic departments• New and larger Trauma care/Emergency

department• New operating rooms• Up-gradation of existing spaces• Executive rooms/SuitesWhen the full redevelopment is complete, the hospital will have more capacity to meet the needs of growing and aging population.

Renovate versus Replace versus Setting up a new centre in a peripheral locationDue diligence must be performed and all three options examined and outlined to the board/Investors for decision making. Engage professionals in master facility planning and investment banking to assist with the process of comparing cost, quality and risk as well as the advantages and limitations of each option. Alternatively, you may want to expand your business into targeted geographic areas to attract well-insured patients. A trial for this could be in the form of setting up outpatient and/or diagnostic services in that region & see the response of the business. The results from this trial could be a major source of your decision making. Expansion should ideally be done to cater to a wider catchment area by selecting the site/existing building after doing a detailed research on the type/size of the hospital to be set up for maximising the project output. On the other hand, renovation can be a cost-effective and appeasing option, but it also is the most complicated one owing to the structural challenges • Plan to minimize interruptions of day-to-

day operations.• Train staff and contractors to prevent the

spread of infections during construction.• Work flow processes are redeveloped to

eliminate inefficiencies.• Plan all phases to avoid issues with space

utilization over the long term.• Take into account that the site needs to

allow for future expansion.• Include projected operating costs

associated with maintaining multiple systems, such as HVAC.

Be aware that the cost to renovate could compare to that of building a replacement facility, if the renovation includes significant changes & the project may lose momentum & deliver less satisfying outcome. The process of building a new hospital is always rewarding, but there are many challenges and financial barriers every hospital management team must overcome before it moves forward with its own renovation or construction project.

Dr. Vinod Singh Founder & consultant

Hospitech Healthcare

For More information read next issue..........


COVERSTORY


COVERSTORY

HOW TO SET UP AN IVD DIAgnoStIC lAborAtory

Many hospitals and stand alone laboratories, when they think of setting up a new laboratory

find a small basement room or a cramped corner in the building. The laboratory should be spacious enough to accommodate the present work load and keeping the next 10 to 15 years in mind. If phlebotomy also has to take place in the lab then adequate seating and toilet facilities should be taken care of. If samples are collected in wards and remote sites, then sample transportation also should be taken care of. Now there are pneumatic transportation and advanced robotic transportation systems are available. The samples are received by the lab, and registration takes place with bar coding of the samples with enough bar code labels for secondary tubes. The samples are then centrifuged and this step is the bottleneck in most of the labs. Therefore enough centrifuges are to be provided. The serum or plasma is taken to the analysers in the primary tubes itself or can be liquated in to secondary tubes. If the workload is very high then automated pre-analytical equipment which can centrifuge, decap, make aliquots with labels and even load the samples to analyser specific tubes could be employed. Now the samples are transferred to the analysers manually or by conveyer belts. The laboratories should choose analysers to suit their work load. The labs should also choose the appropriate

technology for the various parameters. For critical parameters it is advisable to keep a spare analyser to meet break downs.Electrolytes: Most of the labs now use ISE (Ion Selective Electrode) for electrolyte measurements and there are also chemical methods. The ISE could be mounted on the chemistry analyser or it could be a standalone unit. The world is now slowly moving towards ICP Mass Spectrophotometer for electrolytes and heavy metals though the instrumentation is quite expensive.Chemistries: Starting from simple colorimeters, semi auto analysers, Selective discrete analysers with through put of 100 tests to even 5000 tests/hr are available. There are both wet and dry chemistry analysers available. These analysers can measure end point, kinetic, turbidimetric and nephlometric measurements. There are some modular analysers which can be added on when the increase in work load. Therapeutic drug monitoring, special proteins, glycated haemoglobins etc. Could be measured using the chemistry analysers employing special reagents.Hormones and tumour markers: Though RIA is a good technique now it is not used by most of the labs. EIA, Chemileuminescence, Electro chemileuminescence are the widely used techniques. Different manufacturers use variants of these techniques to produce their kits. Manuel, semiauto and fully automated systems are available. The labs should make their choice based on their work load, sensitivity, & specificity for each parameter. Sometimes a lab may require analysers from more than one manufacturer for their special needs. Electrophoresis: If there is a good work load labs can have automated electrophoresis systems. Now there are even capillary electrophoresis system which is very fast and accurate.

HPLC Systems: There are some labs which use HPLC alone or in combination with Mass Spec. For measurement of drugs, proteins, glycated haemoglobins etc.Other Special Equipments: Some special labs may employ, based on special needs, Atomic Absorption Spectrophotometer, Nephlometre, Osmometer, PCR equipments, Fluorimeter,etc.In addition if haematology, microbiology, pathology labs are also part of the laboratory then appropriate equipments for those area also should be acquired. All laboratories should also provide for air conditioning, good quality distilled water, uninterrupted power supply, cold room or refrigerators for storage of samples and reagents a good computer system for storage of data, inventory etc. The laboratory should also take care of staff room, seminar room, staff training etc. Provision should be made to run Quality control samples to validate the results, Accredit the laboratory with appropriate agencies, and have service contracts for equipments and stock some essential spares for the equipments. If one takes care of all the mentioned points then the laboratory that is established will be one of the Best Laboratories.

Dr. R. Selva KumarChief of Manufacturing operations - IVD Factory


INTERVIEW

Medical booms in India as Apollo hospitals takes the lead in catering international patients and is one of the busiest centre of transplants across the globe

Dr. Anupam SibbalGroup Medical Director

Apollo Hospitals

Any institution of excellence stands on three pillars Clinical, academic

and research excellence

Tell us about yourself and your journey with Apollo Hospitals?I joined the Apollo hospitals in 1997. 1998, we established our first liver transplant program in india, we transplanted a child from Kanchipuram and he is doing well. Its nearly 17 years post transplant and he just finished his school. His success really started liver transplantation in India. The Apollo program has grown the whole liver transplantation scenario over the last decade and a half and has become really well established in india.Please throw some light on Apollo Transplant program and how was your first liver transplant in 1998. Any memories ?In 2012, we became the first program in the world to perform more than a thousands of solid organ transplants ,and on daily basis performed 800. The Apollo transplant program in 2013 and 2014 ,has remained the worlds one of the busiest solid organ transplant program, and Delhi has been the busiest transplant centre in

the world for last 3 years. Last year we have done more than 1000 solid organ transplant, in which more than 300 were liver. I think it’s been very gratifying ,the fact that we have been able to help those with no hope. We have transplanted patients not only from India, but from several countries .what we have been able to do is to give them a life, and they are living normally and are productive members of the society. Like some doctors, journalists started practicing again in their respected professions, and children started going to school, now they are energetic teenagers. It’s been very gratifying for us to see, how in a last decade and a half India has done progress, in the area of liver transplantation .As an academician how do you see medical profession in India and why there is a dearth of professors here. Please tell us?If you look at any institution of excellence, it stands on three pillars clinical excellence ,academic excellence and research excellence, and what we have been trying to do at Apollo over the last few years, is really focusing more and more on academics and research excellence.So we have 800 postgraduate trainees who are receiving training in more than 30 specialties, we have a medical school which is now about to start a fourth batch, and there is a lot of research that we support we have research fellows, we encourage our staff to publish and overall it’s been a fantastic experience to see academics and research are going good.

How do you take India as a medical destination and what’s the role of Apollo hospitals in catering international patients. How many international patients Apollo serves every year?I think there is a huge opportunity now, to sought of galvanize and encourage education because, we have a shortage of doctors in india, and we need to produce more doctors, specialists and I am sure in the years to come, we will see enhancement of education .We see a lot of patients now, and we treat 1.25 million patients every quarter, and 5 million patients every year. We have been fortunate to win the trust of the patients from across the globe, and patients from 121 countries come and visit us for preventive checkups, and specialized care .I think there is a good opportunity for india to become a global healthcare destination .Whats your message on the World Heart Day. Please share with us.?I think it’s extremely important to realize that, heart disease is common in India. So we really need to look after our health .We need to exercise and smoking should be prohibited totally. We also need to have relaxed and healthy lifestyle because, we are at a greater risk of a heart disease and we really need to prevent it .As Medgate today’ is actively involved in the Healthcare industry, and acting as a bridge between doctors, hospitals and patients. hats your take on it.?I think Medgate today is doing a fantastic job, and its very important for the doctors, media and the public to come together and talk about enhancing the health status of our people. I Would like to compliment Medgate for doing this job.


What are the challenges you face in the Healthcare design?Challenges in healthcare design:Hospital is a place where the patient along with their attendants are always in anxiety, so it needs to provide a lively, pleasant inviting ambience and a caring environment. It should be designed in a way that it should do no harm to the patient, on the contrary should facilitate healing. Many common issues like reducing falls, minimizing noise, making environment staff friendly, are still unanswered. We must try to focus on improving the environment for the patients and the care givers. Architects and designers have to keep pace with the advancements going on in medical field, nursing techniques and the client demands. The premises should be designed keeping in mind the physical, mental state of the patient and the attendants. Now the time has changed, even

EXPERTVIeWS

Architect Mauktik Trivedi explains his style of healthcare Architecture and encourages environment friendly designs for better healthcare

I give utmost importance to Space planning-planning is done in a way that maximum use of natural light is taken, even cross ventilation is taken care of so that the whole premises is environment friendly at the same time it gives soothing ambience to the anxious patients and their relatives.Mauktik trividi

Architect

government and some missionary & charitable hospitals focuses on better healthcare facilities, so private and corporate sectors need to upgrade their standards also.Please enlighten us about the trends and demands of Healthcare architecture.?Trends and demands in healthcare:Nowadays the patients’ demands and expectations are increasing, they are expecting good quality service at affordable prices, all the clinical, paraclinical and administrative services to be fast and as per their requirements. Aesthetics is given due importance, be it a multispecialty big hospital or a small private unit. IT has become integral part of our lives and so is in the medical field. All areas should have provision for IT integrity. Every hospital needs to have scope for future expansion to meet the ever increasing demands of medical services by all the class

of people. Advancement in medical science needs a change in healthcare delivery system. Newer diagnostic and therapeutic tools need special energy requirements, controlled environment and other engineering services. Timely completion of the project is equally demanded by the client.What makes your design model different from other architects? My design models are different in so many ways.To mention a few, I give utmost importance to Space planning-planning is done in a way that maximum use of natural light is taken, even cross ventilation is taken care of so that the whole premises is environment friendly at the same time it gives soothing ambience to the anxious patients and their relatives. Areas like game zone in pediatric hospital, relax room for relatives of patients in ICU wards, auditorium for health educational activities is also essential for modern healthcare project. Selection of material-right material for all interiors as well as exteriors to avoid contamination. We have antibacterial paints, fabrics, laminates etc available in market which helps preventing infection. Wise selection of such material pays in a long run.Proper lighting in all areas of hospital is designed in such a way that it does not harm the patient and at the same time proper lighting


EXPERTVIEWS

is available for the clinical work of the patient. Landscaping is also taken care to make the environment more lively and pleasant to those staying in hospital.Handwashing area is allotted separately to avoid cros infection in the hospital.I take enough care to create an environment inside the hospital that not only soothes the ailing patients but also relieves the anxiety of attendants thus making the treatment more easier and effective.Please tell us about your ongoing healthcare project and also brief us about your previous Healthcare projects ?Completed projects:AMRUTA Hospital-situated at RAJKOT, GUJARAT. Its 75 bedded pediatric hospital is state of the art fully equipped hospital with an attractive elevation. It is the biggest pediatric hospital in Gujarat which caters its services only for pediatric population of the region. The architecture has been so designed so as it looks completely well ventilated in all parts though nowhere it receives direct sunrays hence reducing bed smells by killing germs, reducing the need of air conditioners

and thus helping indirectly towards greener planet. Use of vibrant colors gives a very unique baby friendly ambience. It has been cleverly designed so as to include maximum amenities including high tech audiovisual conference room, cafeteria for staff as well as attendees, very attractive game zone, relax room for relatives, etc in a relatively smaller land area making the best possible use of every corner of space.

KRISHNA HOSPITAL at RAJKOT-another 35 bedded pediatric hospital with child friendly ambience and parents friendly environment.

PHYSIOFIT it's a combination of physiotherapy and fitness center at MORBI, near Rajkot, GUJARAT: physiotherapy unit needs special attention in designing where unique instruments installed in accordance with overall designs.

Utmost care was taken in designing the all unique areas keeping in mind the physical state of the patients.

Ongoing / future projects. We have few projects under planning and execution stage, where chain of multi diagnostic clinics, some private hospitals, and very interesting healthcare project with keeping naturopathy in central focus are name a few.Please tell us about your ongoing healthcare project and also brief us about your previous Healthcare projects ?Sustainability in healthcare architecture:We are using maximum natural light, which helps to prevent bacterial growth, direct sunlight where possible, Use maximum of LED very carefully, we strongly suggest not to have any LED on top of patient head, as Light Omitting Diodes (LED) are not good for naked eye and that too for longer period when patient immunity systems are week.Use of local materials, minimum use of energy resources, less use of Air-conditioners, are the key factors for our design solutions.


INTERVIEW

– in the said pursuit, I have been able to successfully develop India’s first Health Spa with Body Rejuvenation Resort at Bangalore – Golden Palms Resort for World Resorts – this development has ended becoming a path-setter for many such spa resorts to follow; my future projects too speak of hospitals as part of large township & campus developments; Also, I have been on panel for various Health-Care events / seminars wherein I have been sharing my experience and design ideas on how health care architecture can be made more interesting and high-tech;You have recently got the award of” Design legend” by Society interiors. What is that quality that separates you from other designers?My firm’s USP is that we are Fast and we are Professional – we have not found a client who is faster than us – and we are very good in design & documentation – it has happened so many times that a client calls me after two decades wanting to review his existing building or needs some information about what was built, and we are able to retrieve the documents / designs, done then, in no time – that’s our USP because of which we have been able to rise above and win many many awards viz. “Top Architects through Decade” CWAB Award 2015, “Design Legend” award by Society Interiors 2015, “Most Promising Brand” award in Architecture & Real Estate at World Brand Summit, Dubai, Hospitality Architecture Award by IDE, “Life Time Achievement Award” by Construction Architecture Update, NDTV Excellence In Architecture Award, ‘CW India’s Top Ten Architect’ & CNBC Awaaz CRISIL’s “High End Interiors’ award & many more;

How an architect should encourage sustainable and eco-friendly design particularly in the healthcare?In my view, ‘Sustainability’ today is a fad, it’s in Vogue – if you honestly ask yourself, sustainability was a way of living in our ancient culture – pick up any historical design and you would find them most sustainable – it’s just that we had got deviated from these facts, we had got influenced from the so called ‘Modern’ designs and had started designing energy guzzlers and eco-dampening structures – I have always been designing sustainable structures, thus implementing the same in healthcare should not be different and difficult – important would be to design the structure in a very eco-friendly manner, keeping the basics of earth and solar features in mind – once that is done more than half of the target is achieved, while the use of eco-friendly systems and sustainable products fill in the balance requirement;How do you see the Indian architecture and model of designs as compared to the west?Indian Architecture has a very rich history, most of which is based on the scientific principals of life, it is not

only eco-friendly, sustainable, but very ergonomic and humane. Western architecture is good for western countries, while our architecture is more suitable to Indian style and standards of living / working. Having said the above western adaptation has always been there in our architecture and shall remain to a great extent, however similar Indian principals too are recently being adopted by many international architects in their designs – thus a exchange of ideas / cultures is doing just fine. As Architects what we have been doing is planning the structure completely on Indian principals of design, while a lot of technology and materials are being used in their own adaptive form, there by creating the right balance.Do you think that Architecture industry is evolving now in India?This field is an ever evolving one! In my view an Architect is next to God, he has to foresee the changes expected and plan for it atleast 30 to 40 years ahead. Architecture is one art which has everything to do with human & other animal population, thus with the evolution of mankind the field too is evolving, vastly.


INTERVIEW

Being a legend in the Healthcare Architecture. Please enlighten us about your journey ?At the initial stages of my career I worked with Delhi’s Pradhan Ghosh & Associates for 3 years. After this, I joined the Tata Institute of Fundamental Research where I was involved in a project called Semi-conductor complex. The project duration was planned for three years however we could manage to complete the working on this project in just a year. This made the government churn out 3 increments at a time for these architects ;a rarity in those times. During this period I got another “chance of a lifetime”, which is to work at BARC.I worked on numerous path-breaking projects at BARC; one of them being creating a lab with clean rooms for a class 10,000.After working with the planning department in TIFR and then the exposure to atomic plants

[at BARC], I moved towards aviation in International Airports Authority of India (IAAI). I was involved in airport planning and during that time I was familiarized with the concept of Aerobridges which was non existent in India at that time. I was actively involved in the planning of the four metro airports. After working for more than 3 years in aviation, I got an opportunity to work with DGHS, Ministry of Health & Family welfare, and now I am retired after serving as Chief Architect in the ministry & presently Advisor to HLL Lifecare Ltd. A Govt. of India Enterprise and Visiting Professor with London South Bank University.What are the critical aspects that healthcare architects need to concentrate on ?Infection Control and patient Safety, maintaining desired IAQ (Indoor Air Quality), easy way findings (Signage), Patient & staff centric Design, acoustic controlled environment, and finally synergizing views and requirements of various stakeholder while designing the Healthcare projects with Evidence Based Design and Sustainability as the Key.Whats your take on the Healing Design in Healthcare Architecture?One of the main off-shoots of this journey is that it allows you to iew ‘NATURE’ with more compassion and intensity. Moreover, when nature enters any domain, including architecture there is a different kind of chemistry that comes in to play. You suddenly became more aware, ‘activity’ recedes and it is replaced by ‘action’. Sensitivity to all; be it the climate, the sun and wind, sociology, local materials/craftsman, become the bulwark of the design process. Therefore my approach to architecture is more fluid, no doctrines or ‘isms’ no baggage. Each site, each project presents a completely different set of conditions and therefore response cannot be the same: this brings in diversity and the only under-current that exists is the ‘balance’. Evidence Based Design is what it represents in Healthcare healing Architecture.Whats your take on Green architecture or sustainability? Do you think that sustainability is being compromised because of looks in the healthcare architecture ?We should encourage green architecture always while designing for Healthcare as environment also plays a major role in the healing process but unfortunately Architects have compromised sustainability in the field of healthcare design and it is very much unfair too because in the long run it can turn into a major disaster which no one can compensate in any way as it is a matter of lives. So healthcare architects should encourage sustainability for better healthcare which will also benefit the country and future generations.

Dr. Chandrashekhar Former Chief Architect, Govt. of India

Dr. R. Chandrashekhar who revolutionized the healthcare architecture in three decades and made India proud globally gives an insight about Healthcare architecture

One of the main off-shoots of this journey is that it allows you to view ‘NATURE’ with more compassion and intensity. Moreover, when nature enters any domain, including

architecture there is a different kind of chemistry that comes in to play


LINePRODUCT

Nurse-Call SystemsMedisystems Electronic Nurse-Call Systems are modern microcontroller based digital systems. System features have been designed to cater for hospital practices prevailing in India. Hence, the basic audio visual arrangement has been deliberately simplified through an easy to understand red-yellow-green lamp mode with easily recognisable audio chimes. All calls are acknowledgeable, to relieve patient stress, and no call can be cancelled or reset except by visiting the patient bedside. Even trainee nurses placed on ward duty at short notice can adapt to the system in minutes.The system is modular, comprising a

Central Display Console at the nurse-station counter (Optionally, also with Ward Graphic Displays), a Bed Unit module behind each patient's bed and a Handset which reaches out to the patient through a length of flexible cable. A Door Display Unit can also be mounted at the room entrance – with Nurse-Presence Registration. An Emergency Alert Unit can be mounted within the toilet and / or also within the shower stall. Optional features include Nurse Help Request, Patient-Nurse Intercom, Code-Blue Alert, IV-Drip Alert, Instrument Alarm Relay, Additional Call Signals, Call Transfer Facility, Multifunction Handsets, Corridor Display Modules,

Nurse Call Response Monitoring and an SMS Alert facility for selected emergency calls to be forwarded directly to cell phones.

Bed-Head PanelsMedisystems Bed-Head Panels are specially fabricated for hospital use and designed to converge all the essential utilities around a patient’s bed. Standard panels are available for ICU, Wards, Private Rooms / Suites. The circuit protected panels carry provision for electrical power, illumination, communications, Bio-signals, data, time and medical gas. A stainless steel universal medical rail is also provided for holding a range of accessories like Utility baskets, Case sheet holders, Blood Pressure instrument holders, I-V Poles, etc. Patient-Bed Lamps may also accompany the panels.Constructed from light weight extruded aluminium sheets and sections and stainless steel, and surface treated with an epoxy-polyester powder coat ensures a lifetime protection to the metal surface. It facilitates ease of cleaning and ability to withstand damage from common hospital fluids like saline, drugs, blood etc. These light weight panels can also be mounted on non brick walls made of siporex or gypsum board. All panels have safety metal partitions between high voltage, low voltage and medical gas outlets.Medisystems manufactures a very wide range of such panels to meet practically every kind of need. Such panels are also available in custom configurations which include horizontal, vertical or wall angular orientation, in colours and finish of choice.

Call Systems, Bed-Head Panels, Pendants


LINePRODUCT

OPD Patient-Call SystemsMedisystems OPD Patient-Call Systems are the ideal solution for queue management in busy crowded OPDs. Their configuration is based upon the number of consulting rooms and waiting areas of the OPD. The system consists of a Main Display Unit for the waiting area; door display units and desk units for the consulting rooms. The receptionist or cashier can also be connected to this system with additional desk units. The system scrolls all un-answered calls and can also remind for any un-attended calls. A lower programmable display line can carry social or promotional messages for the hospital. Bilingual displays can also be given. The system once installed is user-friendly, cost- effective and needs minimal support.

OT/ICU Ceiling PendantsMedisystems manufactures OT and ICU Pendants in rigid, single arm and double arm configurations. They are fabricated from Aluminium or pure 304 Grade Stainless Steel sheets and extrusions. The suspension limb is a seamless extruded SS 304 tube of 100 mm dia. mounted with anchor bolts at the true ceiling and a cosmetic flange at the false ceiling. The main pendant body can be made in stainless steel or powder coated aluminium, as desired.

The pendants carry provisions for upto six medical gas outlets, eight electrical outlets and data terminals. The pendant can provide entry of medical gas lines, data and electrical terminals on all sides. Electrical outlets can be mounted on a utility backbone which supports upto 4 shelves. These shelves can be employed for placing monitoring, anaesthesiology or other diagnostic/ therapeutic instruments. A utility pole for I-V dispensation can also be provided alongside the shelf array.

CR Medisystems Pvt. Ltd.Mumbai, India.

Tel: 91-022-23094416, 23004930E-Mail: [email protected]

Web: www.medisystems.in


• High product flexibility: From nurse calls through to multimedia communications - all with a single cable

• Many functions upon request: Billing systems, care data logging, mobile apps and much more.

• Deployment in more than 40 countries including India at best of the hospitals.

Schrack Seconet is happy to present its “VISOCALL IP” intelligent nurse call system. The only certified “Nurse Call System” to use “full IP” sets the standard

internationally for the industry, with the constant expansion of the product portfolio underlining the platform's strength in innovation. All components are developed and manufactured in Europe.

More efficient integrated work flowsHospitals, homes for the elderly and care homes have an upwardly open system in the shape of VISOCALL IP, which they can configure as required: The system covers all the standard functions of a nurse call system, while also addressing many other requirements. Using its own network, a complete communications system can be formed. For a wide array of functions such as a “nurse call system, IP telephony handsets, smartcard billing, Intranet and Internet access, electro acoustic (ELAC) systems as well as video streaming applications in a single system”, it is only necessary to lay a single cable, while the integration of several systems into a single platform reduces the required total investment and saves costs during day-to-day operation. Edwin Fisar, Product Manager for Communications Systems at Schrack Seconet, explains: "There are various different replicated services that are in use today in hospitals and care facilities in various areas. This means higher costs for acquisition, in day-to-day operation as well as for expanding systems. Moreover, the systems are not always fully compatible with one another. By contrast, VISOCALL IP's motto is 'ALL IN ONE, ONE FOR ALL' – as an integrated system with maximum efficiency for all our customers' requirements."

VISOCALL IP: Platform for a convergent networkVISOCALL IP forms a failure-safe seamless communications network with a uniform interface for all people, rooms and facilities in premises. Consequently it fulfils the core tasks of communication, information, safety and efficiency. There is also a strong focus on convenience and entertainment. On screen displays are possible in several languages, patients are able to control all functions with a single device - from operating lighting through to controlling blinds. All this can be done in the conventional manner as well as via a gateway to the KNX/EIB field bus.

A pioneer for the standards VDE0834 and EN60950The whole systems contains its own separate physical cable network for safety reasons, which conforms with the requirements of standard VDE0834, which takes on a structured cabling approach, with all interfaces conforming 100% with European Standard EN60950. All configuration data and log data is stored in the relevant system devices. As no centralized system control is necessary, a complete system failure can also not occur. The system components are self-monitoring. In the event that a module fails, its failure is automatically recognised and messages forwarded to the relevant technician via various system interfaces.

SecoCareAPP: Full information for staff members on the moveMobile applications also make some procedures easier in hospitals and care homes. The SecoCareAPP runs on smart phones and tablets using the Android and iOS operating systems. It transfers all calls, emergency calls, alarms and fault messages automatically and without delay to the responsible staff member's mobile devices. The app's functions are particularly advantageous for mobile nursing care and for technical staff. The SecoCareAPP thereby supports efficient and safe care around the clock.

A Unique Nursecall System With Full IP Through to The Patient Bed.

VISOCALL IP FROM

SCHRACK SECONET

LINePRODUCT


EXPERTVIeWS

52

India is the second most populous country after China and the seventh largest country in the world. The population of the country continues to grow on a

daily basis and is estimated to reach soaring heights in the upcoming few years. The longevity of people has also increased given the better available healthcare facilities over the decades. However it is still far from ideal. While the government seems to be working on areas like digitization and improving economic conditions of the country, there’s an enormous wideninggap, which is being observed in the healthcare industry.The healthcare budgets continue to be much lower than what is required to ensure that each citizen gets universal access to healthcare.Many people die everyday due to the lack of affordable medical facilities and secondly, even those who can afford; they can’t get the desired services at the time when they are needed the most, one such case is of organ transplants. The patients have to wait till they find the suitable option. A report of the Investment Commission of India said that the Indian medical industry is growing at the rate of 12 percent every year, which is remarkable. The reasons

that were listed for this growth were raising income levels;increasing elderly population in the country, increase in the lifestyle diseases, a shift from chronic diseases to lifestyle diseases and changing demographics.Even though the medical sector is growing every year, there are still some loopholes that are troubling the resident beneficiaries and medical tourists. Some of them are manpower shortage; it is found that understaffing is a common problem in more than 40 percent of the medical centres and less number of beds. In order to meet the expectations, the government would have to invest USD 20 billion approximately in the upcoming five years.According to a World Health Organisation (WHO) report,India has approximately 860 beds per million population, which is only the one-fifth of the world average. The solution to this problem can only befound if both the government and private players come together and contribute in such a combination that fills up the demand and supply gap.Prime Minister Narendra Modi has made healthcare a priority before entering the election squad. However, after the first budget came many hopes were shattered as the government took a back seat in case of investments in the healthcare industry and infrastructure. Although the government launched the National Health Assurance Mission last October, it apparently has no takers. It seems like that the Indian government is taking cue from US to fill up the deficiencies in the healthcare structure

by opening the private insurance avenue, which is nothing more than an ineffective alternative approach.Instead, the government should focus on building up tertiary care hospitals for curing lifestyle illnesses like flu’s, dengue and malaria. An array of specialty centressuch cardiology,neurology, oncology and orthopaedics are needed.Building up tertiary medical centres will help in boosting medical tourism and maintaining the growth in the graph of the medical revenues.Along with the infrastructure, government needs to work on education and training, which are the most prominent factors for ensuring a stable medical fraternity in India. Additionally, there is a need to continuously work in a public-private-partnership (PPP) on improving the communication strategy so that telemedicine is become a more common possibility.On comparing the two, the public sector and the private sector, we find that more and more people choose private sector medical facilities because of the state-of-the-art technology they use for treating their patients and the quality infrastructure they provide. But this is an ideal case for people, who can afford to avail the services of the private sector hospitals, whereas, the poor individuals who cannot afford to spend that much cannot count on the public sector.We need 7,415 community health centres per 100,000 population, but what we currently have is less than half the number.

A Road Scanning the Indian Healthcare Infrastructure

Scanning the Indian Healthcare Infrastructure

A Road less travelled!By Padma Shri Awardee Dr KK Aggarwal, President HCFI &Honorary Secretary General Indian Medical Association


EXPERTVIEWS

Breast cancers is no.1 killer disease among women in the world which can be detected in

early stages with Awareness of Risk Factors, Prevention and Screening only at regular intervals in various health centres, clinics, hospitals, etc. under any State Govt. to reduce the mortality rate throughout India.There were 155,367 new cases of Breast cancer in the year 2014 and there were more than 60,000 deaths. More than 30% patients i.e. 46,000 were diagnosed in early stages of 0-1 but were treated surgically and could have been treated safely with NUTAS itself and in combination with other modalities for complete cure without any Lumpectomy / Mastectomy in early stages, etc. to treat and save a woman’s most precious organ the Breast.To treat 46,000 patients or more at least 50 NUTAS systems or more will be required in various states of India to provide immediate treatment to patients in OPD only.By the year 2025 the new cases due to breast Cancer will increase to 200,000 as per the WHO report.In India 1 in 10 young Indian women are being diagnosed every year with Fibroadenoma in Breast.It is a benign tumor which too can be treated with NUTAS without any surgery.With the use of NUTAS alone we can treat the above said malignant tumors

in Breast in an OPD itself without surgery with irreversible coagulative necrosis as NUTAS is a replacement of Surgery only but can be followed by Chemo / Radiotherapy for complete cure if it is in metastasis stage but if there is no metastasis then it can be treated safely with NUTAS alone. The metastasis if any can be confirmed with PET-CT now a days.If govt. of India can eradicate the menace of Polio from India by providing Polio drops at the door steps of people, then together we can combat the mortality rate of Breast cancer among women who are the backbone of every family, as no house is complete without a woman in the family, and with awareness, screening, etc. and on confirmation with core biopsy reports the tumor infected with cancer cells in Breast can be treated in an OPD itself with NUTAS, which will ablate the tumor with irreversible coagulative necrosis ( tissue death of cancerous cells ). In early stages between 0-1 normally, there is no metastasis as the cancer cells are confined within the tumor (localized ) which can be ablated without surgery and coagulative necrosis will happen during the treatment itself and there will be immediate freedom from the cancerous cells with no further metastasis to happen, the primary source of cancer which will be confirmed too after 15 days of NUTAS therapy with path analysis. The recurrence of tumor if any at the same spot can be treated free of cost within 3 or more years as

there is no harm to the surrounding healthy tissues if treated again with NUTAS as it is a radiation free energy which completely burns the cancerous tissues within the tumor deep inside the body as the temperature goes up to 90 degrees centigrade within the targeted tumor but nothing will happen on the skin of the patient to treat with.NUTAS is a cancer treatment of 21st century. No hospital stay, Non –invasive, No side effects, No cut, incision or a surgery but Equivalent to Surgery. A boon for surgeons, Patients and the govt. Hospitals can equip themselves with the said technology to treat various solid tumors in Breast, Liver, Kidney, Pancreatic and in Pelvic Area, etc. and the future belongs to NUTAS / HIFU a Non –invasive Ultrasound Tumor Ablation System in an OPD.Risk factors that could be due to a Breast Cancer, the no. 1 killer among women are :

A lump or thickening in an area of the breast

A change in the size or shape of a breast

Dimpling of the skin A change in the shape of your nipple,

particularly if it turns in, sinks into the breast, or has an irregular shape

A blood stained discharge from the nipple

A rash on a nipple or surrounding area

A swelling or lump in your armpitBreast cancer can be treated safely with NUTAS under the guidance of Color Doppler Ultrasound images and using the degassed water as medium, NUTAS focuses high intensity ultrasound generated in vitro on target lesion inside the body. High energy

BREAST CANCER can be completely cured if detected in early stages

Hi-Tech Innovation in the field of Radiology to treat Breast Cancer, etc. which can be treated without

Surgery & Radiation, solid tumors (Benign / Malignant) if detected in early stages with NUTAS a trusted HIFU

technology for 100% Breast Conservancy


EXPERTVIEWS

deposition appears in the focal region which destroys tumor cell structure and results in irreversible coagulative necrosis of tumor tissues. It is focused High Intensity Ultrasound beam to treat tumor with 3-D treatment planning system under the guidance of color Doppler ultrasound images to ablate tumors in-situ ( Benign / Malignant )It is an integrated revolutionary approach for tumor treatment with a dedicated team of Radiologist, Surgeon & Oncologist to treat a patient with utmost safety in our centre at NUTAS. It is the only centre in Delhi and have treated successfully more than 130 patients diagnosed to be suffering from Breast Cancer, etc. from April 2014 to August,2015NUTAS is 100% Breast Conservancy therapy for Breast Cancer and the necrotic carcinoma cells are discharged by alimentary canal or absorbed by the body. The damages are rehabilitated gradually.Advantages of the Treatment:

Painless, woundless, no anaesthesia needed in treatment, real-time positioning and monitoring, 4-dimension treatment. Minimum complications and side

effects, no perforation and skin burn.

Improve the patient's immune system. Increase the curative effect of action therapy and chemotherapeutics.

No wastes and no radioactive contamination, no special protection needed.

Over 9 years' clinical experience, proven safety and efficiency.

Low cost, high efficiency.AbstractHigh-intensity focused ultrasound (NUTAS) is a noninvasive reatment that induces complete coagulative necrosis of a tumour at depth through the intact skin. This study was to explore the possibility of using NUTAS for the treatment of patients with localised breast cancer in a controlled clinical trial. A total of 51 women with biopsy-proven breast cancer (T1–2, N0–2, M0) were randomised to the control group in which modified radical mastectomy was performed, and the HIFU group in which an extracorporeal HIFU ablation of breast cancer was followed by modified radical mastectomy. Short-term follow-up, pathologic

and immunohistochemical stains were performed to assess the therapeutic effects on tumour and complications of HIFU. The results showed that no severe side effect was observed in the HIFU-treated patients. Pathologic findings revealed that HIFU-treated tumour cells underwent complete coagulative necrosis, and tumour vascular vessels were severely damaged. Immunohistochemical staining showed that no expression of PCNA, MMP-9, and CD44v6 was detected within the treated tumour cells in the HIFU group, indicating that the treated tumour cells lost the abilities of proliferation, invasion, and metastasis. It is concluded that, as a noninvasive therapy, NUTAS could be effective, safe, and feasible in the extracorporeal treatment of localised breast cancer. We provide free Consultation, Comprehensive Breast health check up and our treatment charges to treat tumor are lower than the cost of surgery.We provide free Consultation, Comprehensive health check up with B.S.E., Screening, etc.Our treatment charges to treat tumor with NUTAS are lower than the cost of surgery to be followed by Chemo / Radio therapies, Cow Urine Therapy ( Non – toxic ), etc.


DOCTORSpeaK

56

Osteoporosis is a major global public health problem associated with significant morbidity, mortality, and socio-economic burden and has numerous medical

implications. Osteoporosis is a disease where decreased bone strength increases the risk of a broken bone. Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. *Osteoporosis is a condition that can be managed and treated if diagnosed early and accurately. Unfortunately, it is often undiagnosed until a fracture occurs.On this World Osteoporosis Day, 20th Oct 2015 the theme is to “Embrace Better Bone Health”, so it is of utmost importance that we take immediate steps to create awareness and treatment of this disease.Dr. Vishal Peshattiwar, Minimally Invasive & Endoscopic Spine Surgeon, Head of Department, Spine Surgery, Global Hospitals, Mumbai, says, “The incidence of low bone health in India is almost 10 years younger as compared to west and it will only grow. The elderly population is more susceptible to suffer fragility fractures due to various factors which include age, lifestyle choices, dietary habits, medical conditions and treatments. Indians take low protein, low calcium and high carb diet apart from being chronically low on vitamin D, which is not at all good for the bone health. Prevention and treatment include calcium and vitamin D intake, exercise, and regular osteoporosis medications.”There are some risk factors associated for osteoporosis which are out of our control: Sex: Women are much more likely to develop

osteoporosis then men. Age: The older you get, the greater your risk of

osteoporosis. Family history: Having your mother or father experienced

a hip fracture puts you at greater risk of osteoporosis.

Rick factors that could be controlled: DIETARY FACTORS Low calcium intake: Lack of calcium plays a major role

in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.

Eating disorders: People who have anorexia are at higher risk of osteoporosis. Low food intake can reduce

the number of calories and amount of protein and calcium ingested. In women, anorexia can stop menstruation, leading to weaker bones.

LIFESTYLE FACTORS Sedentary lifestyle: People who spend a lot of time

sitting have a higher risk of osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones.

Excessive alcohol consumption: Regular consumption of more than two alcoholic drinks increases your risk of osteoporosis.

Tobacco addiction Lack of exposure to sunlightDr. Peshattiwar adds, “The incidence of osteoporosis in women is higher in India and DEXA, is the most common osteoporosis test. Dual X-ray absorptiometry is highly recommended for every women aged 40 years and above to do it once in a year. It measures people’s spine, hip or total body bone density to help gauge fracture risk. The major factor in the low Bone Mineral Density (BMD) and poor bone health of Indians is the high prevalence of vitamin D deficiency. Poor sunlight exposure, use of sun blocks, vitamin D-deficient diet, low calcium intake nutrition are some obvious causes for this. Healthy lifestyle, diet, exercise and sunlight exposure can have a major positive impact on the bone metabolism and bone health of Indians. These public health measures are recommended for the population at large as they are efficacious, safe and cost-effective.Women population are more prone to osteoporosis therefore it is necessary to create awareness among women and their families, irrespective of their geographic location, about the risk of osteoporosis and educate those regarding preventive measures to avoid future fractures secondary to osteoporosis. There is also a need for early interventions like adequate calcium intake, vitamin D supplementation, and other lifestyle changes. Steps need to be taken at policy level for devising strategies to tackle this increasing global health problem and stopping it from becoming an epidemic.

DON’T IGNORE YOUR BONE HEALTH

Dr. Vishal Peshattiwar

Once the world learns your name

HISTORY WON'T FORGET YOUR FAMEContact: 9810280351

Tel: 011-26981342

MOST Prestigious & Recognized AwArdin Healthcare Sector

Nomination

OPENwww.medgatetoday.inMedia Partner Powered by Process Advisor


EXPERTVIEWS

58

Documents provide official information or evidence. In the context of medico-legal

aspects of medical records, it is said that “Nothing is more devastating to an innocent physician’s defense against the allegations of medical malpractice than an inaccurate of skimpy medical record.” Medical Record

Medical record is not only a statement providing an official information or evidence about a patient, but is a clinical, scientific, administrative and legal document related to patient care. Medical record contains significant data recorded in the sequence of events to justify the diagnosis and warrant the treatment and the end results.

Medical record should be clear, concise, correct, complete and chronological record of the patient’s illness. It should also include course of the disease, the investigations done with results, diagnosis, treatment measures instituted, and the extent of recovery there from.

What is a Medico-Legal Case?

Any case of medical injury or ailment where some criminality is involved is

called a Medico-Legal Case (MLC). A MLC is where a person is injured or harmed in any way and needs medical attention for it. Injury cases which suggest some criminal offence also come under the MLC.

MLC can be defined as a case of injury or ailment in which investigations by law enforcement agencies are essential to fix the responsibility regarding the causation of the said injury or ailment. In simple language, it is a medical case with legal implications for the attending doctor, after eliciting history and examining patient, thinks that some investigation by law enforcement agencies is essential.

Sample of Medico-Legal Cases

There is no specialty which is immune from being the target of litigation. The most common specialties which have medico-legal issues are Orthopedics, Obstetrics/Gynecology, Plastic and Reconstructive Surgery and Radiology. Some examples of MLCs include: Burn and thermal injuries, vehicular accidents, suspected homicide/murder, poisoning and suicide, sexual assault, and criminal abortion.

Importance of Medical Records in

Medico-Legal CasesFollowing are examples of a few specialties which are vulnerable to malpractice suits:

Obstetrics and Gynecology

��In the U.S., 80% of Ob/Gyn can expect to be sued one or more times in their career.

��An increasing number of Obstetricians have quit practicing obstetrics.

��Errors in antenatal care resulting in wrongful birth, wrongful life (birth of a damaged child), wrongful conception and wrongful death.

Orthopedics

In order to avoid malpractice suits, especially in trauma cases, orthopedic surgeons should take complete initial history and conduct thorough examination; order correct radiographs; patient must be seen by a Consultant in A&E or orthopedic; have complete treatment plan; timing of the surgery must be right; and operation should be carried out by appropriate level of surgeon. Orthopedic surgeon should have a thorough understanding of diverse aspect of medico-legal issues in clinical practice.


EXPERTVIEWS

Radiology

It is extremely important not to miss radiological findings and look for radiological error reports. Radiologist should be alert and observant at all times. Timely and comprehensive communication with referring physician and patient can minimize law suits.

Anesthesiology

Death on operating table (DOT) calls for postmortem, and police investigation. It is a MLC. Police can seize belongings of the deceased, broken ampoules of drugs used and even seal the operation theater after taking over the dead body. In spite of continuing advances in anesthesiology, the profession has inherent risks and there can be complications. Outstanding communication with the surgeon and preoperative communication with the patient and family is the key, to minimal lawsuits. Adhering to the standard of care is a prerequisite to being a successful anesthesiologist.

Causes of Patient Injury

The top factors that actually contributed to patient injury, based on expert review of the data are:��Problems with clinical

judgment (38%)��Technical skills (23%)��Communication (22%)��Patient behaviors (20%)��System failures (14%)��Documentation (13%)

Medico-Legal Register

��A medico-legal register should be maintained in the casualty of every hospital.

��Details of all MLCs should be entered in this register including the time and date of examination and the name of the doctor who is dealing with the case.

��This would be of immense help when the patient through the court/the police, requests for a copy of the medico-legal report.

��A case may be register as an MLC even if it is brought several days after the incident.

ConclusionIgnorance of medico-legal aspects of medical care is no longer a bliss to physicians or hospitals. A lot has changed since the landmark ruling in Parmanand Kataria vs. Union of India (Supreme Court, 1989) which was the

basis of framing the Right to Life Act. Medical care must be provided to the patient in need of it! Several research studies have concluded that refined communication with the patient and the family can reduce the possibility of MLC in a high majority of cases. It is recommended that medical students during their undergraduate studies as well as hospitals include the essentials of effective communication as an integral part of studies and continuing medical education programs sponsored by the hospitals, medical associations as well as the respective medical councils at the state and national levels. By taking this recommendation seriously and implementing it with the assistance of professionals in communications will be the best investment that can be made to save the dedicated medical practitioners from un-imaginable mental stress which can take a toll on their medical practice.

Prof. M. Habeeb GhatalaDean and Member of the Board of Directors

Princess Durru Shehvar Children’s & General Hospital, Hyderabad


EXPERTVIEWS

Healthcare in India is in a state of transition where state governments as well

as the government at the centre have launched several initiatives to make healthcare affordable and accessible to all. However, given the low penetration of health cover in India, there is huge scope for the sector to innovate and introduce best practices using robust technology as a backbone and make basic healthcare accessible to all citizens. The sector also offers huge scope for leveraging technology to standardize procedures and make delivery systems efficient thus ensuring reach, growth and profitability for the sector.

The Provider is Key A key player in the healthcare chain is the provider – the hospital. Without the right hospital infrastructure, it will not be possible to cater to the scaling healthcare needs in India. It is thus, crucial for hospitals to constantly evolve and adopt latest innovations and be on par with the global best practices.

TechnologyOne major area where technological implementation is lacking is the healthcare insurance claims adjudication process. Currently, majority of the health insurance claims are handled manually where all information from the first stage of filing a claim to the last stage of settlement is entered and processed manually. This practice leaves a lot of scope for errors and misinterpretation of data, and also requires physical storage of tons of paperwork that is always at a risk of getting destroyed or lost. Further, manual processes leave more scope for continuous back and forth between the hospital and the insurance company/TPA, adding to the inefficiencies and delays.

The ImpactIn order to efficiently serve the needs of the consumers, hospitals need to ensure a quick turnaround time in healthcare insurance claims adjudication. It has a direct impact on the time taken to discharge a patient and have beds and other resources available in time for the incoming patients. The need is of a platform supported by strong technology that is standard, automated and scalable. Implementation of such technology can plug the loopholes at every stage; enhance over efficiency and in turn lead to customer delight as well as profitability.

Reduced Turnaround time:Quicker approvals enabled by a standardized electronic platform speeds up the time taken to process discharge significantly. Owing to rising demands for hospitalization needs, hospitals have a huge influx of incoming patients and the ability to make discharges faster will enable them to manage bed utilization and other resources better thus, reducing the waiting time

Paving the Way for Innovation in Healthcare Insurance

for incoming and outgoing patients. Making optimum use of resources also, add greatly to the profitability of hospitals.

Integration with HIS:

Hospitals adopt various Hospital Information Systems (HIS) to enable the internal processes and administration. However, to make the claim adjudication process completely efficient, HIS needs to be integrated with the electronic platform where the data that needs to be sent to the payer is exchanged directly from the HIS without the need for human intervention to enter data or fill forms at the hospital thus, reducing the possibility of errors. Integration of Remedinet with HIS enables the hospital to implement a seamless electronic channel for exchange of information with the payer. It not only eliminates the need for human involvement but also increases efficiency and accuracy, enhances reliability, and leads to profitability for the hospital.

Improved overall efficiency:

A technology platform such as Remedinet makes it possible to identify lags or delays and fix the error in real-time. Quick responses to queries raised, real time tracking of the claims process, and retrievable archives become possible too. Handy SMS and email alerts based on pre-defined trigger points add to the hospitals and payers ability to manage the entire claim processing cycle better. Since, such platforms allow all data to be exchanged electronically, the need to store data physically is also eliminated as all data history will be available with the click of a button and will be easily retrievable, which also helps to save costs.

Munish DagaCEO, Remedinet Technologies


EXPERTVIEWS

62

Medical Inventions That Save LivesStudies have shown that 60 per

cent of all cardiac diseases are due to Sudden Cardiac Arrest

occurring due to arrhythmias. Sudden cardiac Arrest (SCA) is among the most common causes of death throughout the world. It is estimated that more than 3 million people die yearly from SCA, with a survival rate of less than 1%.

Sudden cardiac arrest occurs most frequently in adults in their mid-30s to mid-40s, and affects men twice as often as it does women.

When SCA strikes, and often without any warning or symptoms, it requires immediate action for survival. Survival can be as high as 90 percent if treatment is initiated within the first minutes after sudden cardiac arrest. The rate decreases by about 10 percent each minute longer. While CPR can keep some blood flowing to your heart and brain for a short time, the most effective way to treat sudden cardiac arrest and restore heart’s normal rhythm is by defibrillation. The American Heart Association recommends defibrillation within 3 to 5 minutes of arrest, or sooner, for sudden cardiac arrests occurring outside the hospital.

Newer technologies in past few years have emerged as device therapy for arrhythmias- ICDs and Pacemakers and device therapy for heart failure - Cardiac Resynchronisation Therapy- CRT).

Pacemakers – restoring the rhythm of life

A permanent pacemaker is an implanted device that provides electrical stimuli, thereby causing cardiac contraction when intrinsic myocardial electrical activity is inappropriately slow or absent.

From a simple pacing sensing functionality, they have evolved over a period of time to almost mimic the heart functioning. There are Rate Responsive Pacemakers (RRPs), which adjust the rate at which the heart is paced based on the activity of the patient and have gone from single, dual to triple chamber pacing today depending on the patients need. Advanced features to ensure patient safety, 100% pacing support when required, atrial arrhythmia prevention and management has made pacemakers very effective in managing bradyarrhythmias and improving the quality of life significantly.

Implantable Cardioverter Defibrillators (ICD) – an emergency room in the chest

An implantable cardioverter-defibrillator

(ICD) is a specialized device designed to

directly treat cardiac tachyarrhythmias. ICDs have revolutionized the treatment of patients at risk for sudden cardiac

death due to ventricular tachyarrhythmia

Patients at high risk for sudden cardiac arrest:

Post heart-attack patients with low pumping function (EF <35%)

Additional risk factors such as NSVTs (non-sustained ventricular tachycardia), PVCs (premature ventricular contraction) and syncope / presyncope increase the risk of SCA in post MI patients and can be assessed through echo and ECG tests

An (ICD) is designed to monitor your heart rhythm 24 hours a day. If your heart is beating too fast or irregularly, the device will first send small painless electrical signals to correct your heart rate. If the fast heart rate continues, the defibrillator will deliver a shock to restore your heart to a normal rate. The ICD is like an emergency room in the chest preventing sudden cardiac death due to fast rates. Novel programming algorithms that reduce administration of unnecessary shocks and allows for remote monitoring, so that the patient is managed from his home reducing his hospital visits, has brought a new ray of hope amongst heart patients.


EXPERTVIEWS

Recently cardiac devices industry has yielded an interesting innovation with regard to pacemakers and ICDs which has increased its use in clinical practice phenomenally. These devices are embedded with new technology that allows for full-body MRI scans among patients with these devices. It is estimated that as many as 63 % of patients will need an MRI within 10 years of receiving a device. Furthermore, 85 percent of all pacemaker patients have one or more comorbidities, making comprehensive multi-specialty care, including access to MRI, important in today’s environment. Until the availability of MR-Conditional pacemaker and ICD systems, patients with devices have been contraindicated from receiving MRI scans because of potential interactions between the MRI and device function, which in turn affects the diagnosis and treatment.

The SureScan® technology is an approved technology resulting in a growing number of implantable cardiac devices that are approved for use in an MRI (magnetic resonance imaging) environment.

Cardiac Resynchronization Therapy – resynchronize the heart and improve quality of life

Heart failure in India has been conservatively estimated to affect up to 4.6 million people, with up to 1.8 million new diagnoses made each year. Heart failure is a progressive disease associated with symptoms such as

Dr. T. S. Kler

breathlessness, frequent urination, systemic and pulmonary edema requiring frequent hospitalisations to decompensate, all severely affecting the quality of life. Also repeated heart failure hospitalisations are associated with increased mortality.

Cardiac resynchronisation therapy (CRT) is a way of treating heart failure; this device uses tiny electrical pulses to both ventricles (lower chambers) of the heart to make them beat together again in a more synchronised pattern.

Latest addition in cardiac devices for heart failure patients is a cardiac resynchronisation device which coordinates the left and right ventricular contractions and improves the heart’s pumping efficiency. Infact the latest AdaptivCRT® algorithm, is the only algorithm demonstrated to improve heart failure patients’ response to the therapy and reduce the risk of atrial fibrillation (as compared to conventional biventricular therapy). This device automatically adapts to patient’s needs, continuously optimizes therapy, improves response rate and reduces heart failure hospitalizations.

While technology innovation is generating newer and better devices & improving clinical outcomes in cardiac patients, it is quintessential to create awareness amongst the masses about the disease progression and risks and enable them to make informed decisions about choosing the right treatment at the right time to enjoy a healthy & quality rich lifestyle.

MD, DM, MRCP, FRCP (U.K), FACC, D.Sc, (HONORIS CAUSA)AWARDED `PADMA BHUSHAN – 2005

EXECUTIVE DIRECTOR (CARDIAC SCIENCES) ESCORTS HEART INSTITUTE & RESEARCH CENTRE

OKHLA ROAD, NEW DELHI – 110025


INTERVIEW

What are the challenges in the healthcare architecture and how do you tackle it ?Healthcare design and planning is one of the many specialized fields in design and needs a strong technical knowledge, understanding of the process of the health care provider, functioning of the hospital, methods and operation systems of the administration, nursing, staffing, the various departments and specialties as well as their technical functioning, the equipment that are required and the latest technologies used for diagnostics as well as treatment and surgeries.

Challenges also lie in understanding the cultural, geographical and historical influences which affect the functioning, patient experience, grieving manners, bedside manners, visitor experience and impact on the space planning and design, length of stay and many other factors naming a few. It’s important to research, question, survey whenever you enter a new geographical or cultural market to understand all these factors. Another huge challenge is to be able to create an aesthetically pleasing and healing spaces while concentrating on all the technical working of the healthcare designs and making sure spaces are created as relaxation and soft spaces or even some spiritual spaces for the patients, families, visitors, children and all age groups even though they might not be the direct money generating areas. A lot of the time due to space constraint and other factors, these crucial points which affect the emotions and overall healthcare experience get missed out or even eliminated. What are the various points that you keep in mind, while developing the healthcare design?

Healthcare priorities and technical knowledge about the hospital environment must be in mind while designing for Healthcare.

Flexibility and future needs planning as well as 3/5/10 year planning is very critical while designing at initial stages due to changing models of care, associated care pathways and emerging needs and technologies or even complete change of use and functions in the space or new department additions. This is a critical point as many healthcare facilities do not keep expansion in mind and fall apart.Creating a therapeutic environment is essential. Healthcare facilities should be non-threatening to patients and visitors, support a more effective recovery and provide a working environment that attracts and retains staff. A healing environment design must keep in mind factors like enhanced natural daylight, privacy and dignity of patients, acoustic sensitivity, occupant control, human scale, ease of way-finding, a relaxed and accessible outlook and reduced transmission of infection. Do you think that a proper healthcare design can give a boost to sustainable environment?In the ideal world, sustainable design and the creation of healthy healing environments should not be seen as a new phenomenon and should typically complement each other. Creating environments that promote healing

Creating a therapeutic environment is essential.

Healthcare facilities should be non-threatening to patients and visitors,

support a more effective recovery and provide a

working environment that attracts and retains staff. A healing environment

design must keep in mind factors like enhanced

natural daylight, privacy and dignity of patients,

acoustic sensitivity, occupant control, human

scale, ease of way-finding, a relaxed and accessible

outlook and reduced transmission of infection

Shilpa Jain BalvallyArchitect


INTERVIEW

complements the development and practice of treatments that heal. Yet hospitals historically have not been among the healthiest environments. It’s challenging to design and operate hospitals sustainably due to the complexity and high cost of designing and building healthcare facilities today. Regardless of its size or location, with cost per square foot as a driver space is at a premium.One of the most important elements of a sustainable design model is economic flexibility.It is important to move away from first-cost dominated procurement processes to a whole-life cost model where design, construction, maintenance, energy and operational costs are considered at the earliest stage of the design process and all decisions are made with the life of the facility in mind.Any design must therefore be flexible and adaptable to meet future changes and needs , thus making it sustainable in the long run keeping in mind .Hospitals and other healthcare centers are generally huge spaces involving a large number of people and generate a lot of different kinds of recycled and other dangerous wastes. The aim is to improve employee safety (real and perceived) by reducing environmental exposure to toxic materials (drugs, cleaning supplies, building materials).Also topping this list is the need to reduce energy and waste costs.Patients and staff value daylight and a connection with the exterior. Priority one, is to site the building properly. Specifying the correct amount of insulation and balancing daylight and heat gain/loss is critical when designing the building exterior. Owners also need to ensure that technical aspects of products are adhered to as the building takes shape (for example, commissioning of the energy-consuming systems as well as critical systems, including emergency power and fire alarm/suppression systems)What is the concept of healing design?When you think of a healing environment, what comes to mind? A spa? A zen garden? Perhaps a corner of your house or a beach? Not many would think of a healthcare facility. But that view is beginning to change as hospitals are becoming aware of

the growing body of evidence that shows the benefits of a healing environment, and are incorporating ideas generated by such studies into new facilities.It’s important to design a therapeutic environment which eventually help financially in the long run. Good indoor air quality can improve recovery at times, good energy design can cut utility costs, the use of natural light can improve productivity and patient outcomes, and appropriate interior finish and material selection can reduce cleaning and maintenance costs.Such environments can reduce stress and anxiety, which positively affects our health in a number of ways. For example, a noisy, confusing hospital room might leave a patient not only feeling worried, sad, or helpless but also might raise his or her blood pressure and heart rate and increase muscle tension whereas a large window with soothing daylight or a nice artwork with soothing colours in the room will do exactly the opposite.Much of this research has shown that the conventional way hospitals have been designed with their bland color schemes, hallways that echo, cramped patient rooms, and loud, overhead paging systems, contributes to stress.This not only can hinder a patient’s ability to heal but also can affect the productivity of staff. Because of poor design, nurses in

most hospitals spend a great deal of time gathering what they need to provide care. One study showed that almost one-third of nurses’ time was spent walking. If facilities were designed more efficiently, nurses could instead spend that time with patients.Could you please tell us about the Healthcare projects that u have worked on recently and also enlighten us about ongoing projects in the Healthcare?While working in the United States with renowned Healthcare design firms, I worked on various large Healthcare projects like Children’sHospital of Orange County amongst others which was a 4million sf Hospital with various departments and expansions in mind. After I and Sameer moved to India to set up their practice Studio Osmosis, we already worked on detailed space-planning, design, Specialized rooms planning, equipment coordination for Motherhood maternity Hospitals in Bengaluru as well as Womens and ChildrensCenter for Obgyn/IVF and also planned large scale Day Surgery centers and Hospitals in Jeddah, Saudi Arabia which are over 1,00,000 sf.in size.Motherhood, the premium birthing boutique and woman & child healthcare provide was awarded with ‘Healthcare


INTERVIEW

68

Excellence Award’ as the best single specialty hospital in Obstetrics &Gynaecology, at the Indo-Global Healthcare Summit & Expo 2014.The 40,000sfMotherhood Maternity Hospitals in Bengaluru are family centered single specialty birthing boutique for women and their newborn,providing state of the art luxury and comfort unified experience for the Mother, child and their families as well the for the staff and administration. It focuses right from prenatal, post natal, pediatrics, consultation and counseling, Fetal medicine as well as NICU/PICU allplanned as per Healthcare standards. We designed international standard suite rooms for expecting mothers and their families offering the best-in-class facilities. State of the art and comfortable LDRs were planned where labor, delivery and recovery happen in one private room, avoiding the stress of shiftingequipped with advanced equipment which is still rare in Indian Hospitals.We have also designed anAdvanced Women & Child Healthcare Centre equipped with ultra-modern medical facilities to provide comprehensive care in Gynaecology, Neonatology and Paediatrics.The Bangalore Fetal Medicine Center (BFMC) was planned meticulously to give this expert care to the unborn baby primary care, making it possible to diagnose and manage genetic and other abnormalities in the fetus. Fetal medicine specialists, sonologists and emotional counsellors provide the most advanced treatment and care at this facility. It was critical for a facility like this to have surplus waiting area and lot of private spaces too due to its function.What are the differences between the Indian Healthcare architecture and the western healthcare architecture?There is a lot of difference in the process of both Healthcare systems itself as well as the design and construction processes in India and the West which impact Healthcare design hugely. Whilst in the west the time given for Master planning, Pre design, Schematic design and User group meetings is a huge percentage of the entire project and construction time, inIndia that time is way lesser, thus impacting the construction and causing various changes later adding majorly to

the cost and time eventually. All this is an impact also of the high real-estate prices in India and lack of clear processes. Culturally, climatically and geographically too the differences are huge between the two zone apart from the fact that the basic Healthcare systems itself work very different thus affecting the planning and designing hugely. Social and family involvement levels are hugely different thus affecting visitors and family participation in the planning. Also, the lack of knowledge and the fact that there are such few Healthcare specialists posts a huge challenge for the owners as well the rest of the team. Lack of infrastructure and space leads to much lesser square footage per bed in the Indian hospitals thus eliminating soft spaces, non-profit generating spaces, multi-shared rooms, narrower corridors, lack of privacy, and healing spaces and also planning for much needed future expansions.What model of business and design you follow specifically in the Healthcare architecture?With a professional specialization (Masters) in Healthcare Design from the Texas A&M University, our healthcare design focuses on research based design and planning, attention to Healing design, understanding the concept and project at a holistic level including future planning and expansions and then moving to a micro level after understanding the user groups, their processes, current and future systems, patient groups, cultural and geographical impacts. In addition to mandatory functional aspects of planning and designing a hospital, we discuss and debate with all involved

people the emotional and aesthetic aspects of the healthcare environment. Importance is given to exposure of nature for the patients, especially direct sunlight, which promotes faster healing.Factors which are always kept in mind while designing the interiors are strategically located positive distractions like artwork, use of appropriate materials and colours which go a long way in reduction of stress levels of not only the patients but also the attendants, hospital staff and doctors as well, thereby enhancing productivity. Visitor spaces, family lounges, Material management as well as Waste management of the facility is a huge point of discussion too as due to space constraints they are amongst the first to get reduced or compromised.Please tell us about the present real state scenario and future advancements in the architecture Industry ?With the two most remarkable events - ‘Make-in-India’ campaign and relaxation of FDI norms in construction sector has also brought in a lot of optimism into the sector and will see its effects in the future. While availability of land parcels are prompting developers to launch projects in the outskirts of 1 and 2 tier cities, lack of requisite social infrastructure provisions in the area is fuelling demand for the large projects. Residential buyers are more interested in smaller homes with basic to mid-level amenities rather than very high-end amenities with high maintenance. Affordable housing is becoming the buzz ever since the political push it has received. Luxury project developers are looking at Foreign brands to create a marketing buzz and justify their pricing.

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